Provider Demographics
NPI:1770785495
Name:INTERNAL MEDICINE CLINIC OF LEXINGTON, INC
Entity type:Organization
Organization Name:INTERNAL MEDICINE CLINIC OF LEXINGTON, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-834-3596
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-0119
Mailing Address - Country:US
Mailing Address - Phone:662-834-3596
Mailing Address - Fax:662-834-3845
Practice Address - Street 1:115 E CHINA ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3624
Practice Address - Country:US
Practice Address - Phone:662-834-3596
Practice Address - Fax:662-834-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07905261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09014701Medicaid
MS09014701Medicaid